The broad, long term objective of the proposed project is to develop effective intervention programs for controlling the epidemic of unintentional prescription drug overdoses in the United States. The specific aims are: (1) to assess the effectiveness of state Prescription Drug Monitoring Programs (PDMPs) in reducing the sales and consumption of prescription drugs; (2) to assess the effectiveness of state PDMPs in reducing unintentional fatalities from prescription drug overdoses; and (3) to examine the association between state PDMPs and the likelihood that a poisoning death is due to unintentional prescription drug overdose. With a marked increase in the sales and consumption of Schedule II pharmaceuticals, the annual numbers of emergency department visits and unintentional deaths related to prescription drug overdoses in the United States have more than doubled since 1999. Claiming over 22,000 lives each year, prescription drug overdose has become the second leading cause of unintentional injury mortality. Previous studies have revealed that the majority of unintentional overdose morbidity and mortality are attributable to nonmedical use of opioid analgesics and benzodiazepines obtained from diversion and 'doctor shopping.' Prevention programs concentrated on physician and patient education have been inadequate to control the ongoing epidemic of prescription drug overdoses. The U.S. federal government in 2002 started the Harold Rogers grant program to support the creation and improvement of state PDMPs. As of January 2010, 34 states have established operational PDMPs, and the Centers for Disease Control and Prevention has recently called for the nationwide adoption of PDMPs. Although PDMPs represent a major policy intervention on the diversion and abuse of prescription drugs, their effectiveness in decreasing illegal transactions and detrimental consequences of prescription drug abuse has not been rigorously evaluated. The proposed project aims to test three hypotheses: (1) PDMP implementation is associated with significantly decreased sales and consumption of prescription drugs; (2) PDMP implementation is associated with significantly decreased mortality from unintentional prescription drug overdoses; and (3) PDMP implementation is associated with a significantly decreased likelihood that a poisoning death is due to unintentional prescription drug overdose. These hypotheses will be tested using quarterly data for the years 1999- 2008 from the Automation of Reports and Consolidated Orders System and the multi-cause-of-death data files, and the linear mixed effects model and multilevel individual response model with adjustment for demographic and socioeconomic factors and serial autocorrelation. Findings from the proposed research can provide much-needed empirical evidence for policy reform and improvement to control the epidemic of prescription drug overdoses. PUBLIC HEALTH RELEVANCE: Morbidity and mortality from unintentional drug overdose in the United States have more than doubled since 1999, mainly due to nonmedical use of opioid analgesics and benzodiazepines obtained through drug diversion and 'doctor shopping.' Physician and patient education programs have been inadequate to control the epidemic of prescription drug overdoses. The proposed project aims to evaluate the effectiveness of state Prescription Drug Monitoring Programs in reducing the sales and consumption of controlled substances and deaths from unintentional overdose of prescription drugs, and to provide scientific evidence for policy interventions on the ongoing epidemic.